Bacteraemia due to Cedecea davisae in a patient with sigmoid colon cancer: a case report and brief review of the literature

Cedecea spp. represent a new member of the Enterobacteriaceae family, and although they are commonly described, they have rarely been reported as causes of invasive infection. The species' inherent resistance to antibiotics makes their management extremely challenging, especially in the context of immunocompromise when infections occur. We hereby report a rare case of Cedecea davisae bacteraemia in a patient with stage IV sigmoid colon cancer followed by a brief review of the literature.     

移植肾结核超声表现及相关文献复习

结核病是实体器官移植术后较为严重的感染性疾病,由于免疫抑制剂的长期使用,器官移植受者结核病的患病率明显高于正常人群[1-2]。结核分枝杆菌感染是肾移植术后最严重、最常见的感染之一,感染部位多为呼吸道和泌尿系统[3]。文献报道,移植肾结核在肾移植术后的发病率可达11.5%,且诊断和治疗较复杂,易造成移植肾功能丧失[4-5]。超声造影(contrast-enhanced ultrasound,CEUS)能客观地反映移植肾的微循环血流灌注情况,有助于提高移植肾病变的诊断率[6-7]。目前有关移植肾结核的超声研究鲜见报道。本文回顾性分析2013年1月至2017年10月在杭州市红十字会医院确诊的4例移植肾结核患者的超声影像学特征,旨在提高对本病的认识,并为临床提供借鉴和参考。     

Dextropropoxyphene hepatotoxicity: four cases and literature review

We report 4 cases of hepatic injury in patients treated with a dextropropoxyphene-paracetamol combination in which the causal relationship with dextropropoxyphene can be suspected. These four cases show similarities with the 29 cases found in international publications. Hepatotoxicity occurs more frequently among old patients and women. Clinically, this condition can mimic a biliary tract disease with sometimes few or no symptoms. Biochemical criteria can show cholestatic, mixed or cytolytic hepatitis. Intrahepatic cholestasis may be found in liver biopsies sometimes suggesting cholangitis. Outcome is favourable on withdrawal of the drug. The mechanism of action of dextropropoxyphene is discussed.     

肾集合管癌的临床病理特点

目的 观察肾集合管癌的临床病理特点.方法 调研病人临床资料,记录肿瘤大体、光镜及电镜下的形态,运用免疫组化检测CK34βE12、CK19、CK13、vimentin、S-100、CEA、Ki-67,并对4例患者进行随访.结果 4例肿瘤主体位于肾髓质,其中2例累及肾周脂肪囊;1例大部分突入肾盂（镜下肿瘤表面尚被覆移行上皮黏膜）;肾集合管癌细胞中等大小,部分胞质嗜酸,部分透亮,部分核呈空泡状,有小核仁,组织结构呈小的腺管状、实片状、乳头状,癌组织间纤维组织增生明显,其中2例伴片状坏死,1例伴大量中性粒细胞浸润;瘤细胞CK34βE12和CK19（＋）,CK13、vimentin、S-100（-）、Ki-67 10%～15%;2例患者术后死亡,2例存活.结论 肾集合管癌是具有特殊形态和免疫表型、预后较差的肿瘤,应通过组织学改变和免疫组化等方法与其他胃肿瘤鉴别.     

Angiodysplasia of the colon: a report of two cases and review of literature

Angiodysplasias of the colon are enlarged and fragile blood vessels in the colon result in occasional loss of blood from the lower gastrointestinal tract. It may be observed incidentally at colonoscopy or patients may present with lower gastrointestinal bleeding. The objective of this case report is to highlight two cases of colonic vascular ectasia seen using a Pentax video colonoscope at the Endoscopy unit of Crescent hospital, Ilorin. The first patient is an 85-year-old man, who presented with constipation, left-sided abdominal pain, and weight loss of two weeks duration. There was no anorexia, abdominal swelling, diarrhea, or hematochezia. Abdomino-pelvic ultrasonography showed normal findings. Colonoscopy done, reaching the ileo-cecal valve and caecum, showed an area of dilated tortuous blood vessel (vascular ectasia) in the wall of the descending colon approximately 45 cm from the anal verge, with no features of bleeding. No ulcers or mass lesion was seen. Colonoscopy showed angiodysplasia of the colon. The second patient is a 30-year-old female trader who presented with two days history of massive hematochezia of about 7 episodes prior to presentation with an estimated blood loss per episode of about 300 ml. There were clinical features of shock. Packed cell volume at presentation was 14%. She was transfused with 4 units of fresh whole blood. Post stabilization, colonoscopy was done 5 days after bleeding had stopped, which revealed an area of erosion with mucosal blood clot about 27 cm from the anal verge. An area of angiodysplasia was seen. No hemorrhoids or mass lesion was seen anywhere in the colon. Angiodysplasia is an uncommon finding in Ilorin. These are the first reported cases of angiodysplasia of the colon from Ilorin, Nigeria.     

Wolfram syndrome: report of four new cases and a review of literature

The Wolfram, or DIDMOAD, syndrome consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness. Diabetes mellitus usually occurs as the first manifestation of this syndrome, followed by the development of optic atrophy, neurosensory hearing loss, and finally diabetes insipidus. We report on four cases with a review of the literature. The diabetes mellitus occurring in these patients is clinically indistinguishable from classic type I diabetes mellitus. Two of three patients continue to have measurable C-peptide secretion 8 yr after onset of diabetes. Two of three patients with Wolfram syndrome had the HLA-DR2 antigen. Combining our cases with those described in the literature, 7 of 11 patients have the HLA-DR2 antigen. The preponderance of the HLA-DR2 antigen in the Wolfram syndrome is different from classic type I diabetes. This is further evidence of the genetic heterogeneity of diabetes mellitus. Although the Wolfram syndrome is rare, it should be considered in diabetic patients with unexplained optic atrophy and hearing loss or with polyuria and polydipsia in the presence of adequate blood sugar control.     

Actinobacillus actinomycetemcomitans endocarditis: a report of four cases and review of the literature.

Four patients with infective endocarditis caused by Actinobacillus actinomycetemcomitans seen at the National Taiwan University Hospital between January 1985 and December 1990 are reported. There were two men and two women with a mean age of 40 years. Three had had a xenograft replacement, the other one had prolapse of mitral valve. Carious teeth were noted in two. The most common presenting symptoms were fever, cough, dyspnoea, and weight loss and the duration of symptoms before diagnosis varied from 2 weeks to 2 months. Peripheral stigmata of endocarditis were not present in any patient. Laboratory investigation revealed haematuria and anaemia in three patients, and elevated erythrocyte sedimentation rates in all four. None had leucocytosis. Echocardiography was performed more than once for each patient and vegetation was demonstrated in only one. Blood culture became positive after 7-10 days of incubation. One of the isolates was resistant to penicillin. The diagnosis was delayed due to the indolent clinical course, non-specific presentation, and the slow growth of the organism. However, all patients were cured clinically and bacteriologically after 6 weeks of intravenous antibiotic therapy which included penicillin, cefamandole, chloramphenicol, or aztreonam, with or without an aminoglycoside. All patients were free of evidence of recurrence after 6-25 months of follow-up.     

甲状腺微小乳头状癌4例报道

甲状腺乳头状癌的诊断一般情况下不难，但微小乳头状癌有时却容易被忽视，以下结合我院4例甲状腺微小乳头状癌进行文献复习，旨在加深对甲状腺微小乳头状癌的了解。     

A primary squamous cell carcinoma of the sigmoid colon in a young patient: A case report and literature review

Colon cancer is among the most common types of cancer with adenocarcinomas being the most common type. Herein we report a young patient who presented with primary colonic squamous cell carcinoma without risk factors. To the best of our knowledge, this is the youngest patient with such diagnosis worldwide.     

Lumbar disc sequestration mimicking a tumor: Report of four cases and a literature review

BACKGROUNDDisc herniation refers to the displacement of disc material beyond its anatomical space. Disc sequestration is defined as migration of the herniated disc fragment into the epidural space, completely separating it from the parent disc. The fragment can move in upward, inferior, and lateral directions, which often causes low back pain and discomfort, abnormal sensation, and movement of lower limbs. The free disc fragments detached from the parent disc often mimic spinal tumors. Tumor like lumbar disc herniation can cause clinical symptoms similar to spinal tumors, such as lumbar soreness, pain, numbness and weakness of lower limbs, radiation pain of lower limbs, etc. It is usually necessary to diagnose the disease according to the doctor''s clinical experience, and make preliminary diagnosis and differential diagnosis with the help of magnetic resonance imaging (MRI) and contrast-enhanced MRI. However, pathological examination is the gold standard that distinguishes tumoral from non-tumoral status. We report four cases of disc herniation mimicking a tumor, and all the pathological results were intervertebral disc tissue.CASE SUMMARYThe first case was a 71-year-old man with low back pain accompanied by left lower extremity radiating pain for 1 year, with exacerbation over the last 2 wk. After admission, MRI revealed a circular T2-hypointense lesion in the spinal canal of the L4 vertebral segment, with enhancement on contrast-enhanced MRI suggesting neurilemmoma. The second case was a 74-year-old man with pain in both knees associated with movement limitation for 3 years, with exacerbation over the last 3 mo. MRI revealed an oval T2-hyperintense lesion in the spinal canal at the L4–5 level, with obvious peripheral enhancement on contrast-enhanced MRI. Thus, neurilemmoma was suspected. The third case was a 53-year-old man who presented with numbness and weakness of the lumbar spine and right lower extremity for 2 wk. MRI revealed a round T2-hyperintense lesion in the spinal canal at the L4–5 level, with obvious rim enhancement on contrast-enhanced MRI. Thus, a spinal tumor was suspected. The fourth case was a 75-year-old man with right lower extremity pain for 2 wk, with exacerbation over the last week. MRI revealed a round T1-isointense lesion in the spinal canal of the L3 vertebral segment and a T2-hyperintense signal from the lesion. There was no obvious enhancement on contrast-enhanced MRI, so a spinal tumor was suspected. All four patients underwent surgery and recovered to ASIA grade E on postoperative days 5, 8, 8, and 6, respectively. All patients had an uneventful postoperative course and fully recovered within 3 mo.CONCLUSIONDisc herniation mimicking a tumor is a relatively rare clinical entity and can be easily misdiagnosed as a spinal tumor. Examinations and tests should be improved preoperatively. Patients should undergo comprehensive preoperative evaluations, and the lesions should be removed surgically and confirmed by pathological diagnosis.     

食管裂孔疝四例误诊报告及文献复习

食管裂孔疝(Esophageal Hiatus Hernia,EHH)是指部分胃底通过增宽的膈食管裂孔进入胸腔.本病在西方国家发病率较我国高,达10%～13%,好发年龄多在50岁以上,女性发病率高于男性[1].国内报道发病率为4.7%[2].本病临床症状多样,易误诊为多系统的疾病.本文报告4例误诊病例,并结合文献分析如下.     

儿童预激性心肌病4例并文献复习

目的 分析4例预激性心肌病患儿的临床特点、治疗及随访,了解该病转归,同时探讨该病的影响因素。 方法 回顾性分析我院4例预激性心肌病患儿临床资料,并复习文献,了解该病转归及影响因素。结果 4例患儿均符合预激性心肌病诊断标准。其中3例行心内电生理学检查,发现存在旁道,给予射频消融术,病例1和病例2预激综合征消失,病例3仍有预激综合征;复查心脏超声示左心室均逐渐回缩,左心室功能均较前明显好转;此病预后良好。病例4尚未行射频消融术,目前正在随访中。结论 射频消融术为预激性心肌病首选治疗方法,预后良好。诊断时年龄、预激的负荷（持续性或间歇性）及预激的类型（旁道位置及数量）是预激性心肌病的影响因素。     

Travel-associated Legionnaires disease: clinical features of 17 cases and a review of the literature

We retrospectively investigated patients with Legionnaires disease (LD) who had been admitted to the Baskent University Alanya Teaching and Research Hospital, Ankara, Turkey, from January 2002 to September 2009. Twenty definitive cases were followed as LD, 17 (85%) of which were travel associated. The mean age was 61.5 ± 9.5 years (range, 39-77 years). Diabetes mellitus was found in 7 (41.2%) of those patients. Gastrointestinal or neurologic abnormalities were found approximately in two-thirds and relative bradycardia in 9 (52.9%). LD was severe in 11 (64.7%) patients, which required intensive care unit follow-up. Although appropriate antibiotic therapy was initiated in all patients on admission day, 4 (23.5%) deaths occurred. In conclusion, clinicians should remain vigilant about the diagnosis of LD in patients with community-acquired pneumonia, especially in the presence of extrapulmonary involvement, risk factors for LD, and a history of recent travel. As in our cases, mortality is still high in sporadic cases despite early appropriate treatment.     

Platelet transfusions in heparin-induced thrombocytopenia: a report of four cases and review of the literature

BACKGROUND: Heparin‐induced thrombocytopenia (HIT) is a complication of heparin therapy associated with thrombocytopenia and thrombosis. The diagnosis of HIT is based on clinical criteria and laboratory tests, including the serotonin release assay (SRA). Because HIT patients are thrombocytopenic, platelet (PLT) transfusions may be contemplated; however, many published reviews have concluded that PLT transfusions are contraindicated in HIT because they may precipitate thrombotic events. This study reports four patients with clinically suspected HIT who received PLT transfusions without complications, and the literature regarding this subject has been reviewed. STUDY DESIGN AND METHODS: Patients with a SRA ordered for suspected HIT were retrospectively identified. Charts of patients with positive SRAs who received a PLT transfusion when HIT was clinically suspected were reviewed for evidence of PLT transfusion safety and efficacy. A comprehensive search of the published literature regarding PLT transfusions in patients with HIT was conducted. RESULTS: A SRA was performed on 189 patients with suspected HIT. Thirteen patients tested positive and 4 of these received a PLT transfusion. No patient developed a thrombotic complication. All 4 patients had adequate posttransfusion PLT increments. Two of the 3 patients with active bleeding had cessation of bleeding after transfusion. Review of the literature revealed no case of a complication clearly attributable to PLT transfusion. CONCLUSION: Four patients with clinically suspected HIT and a positive SRA were transfused PLTs both efficaciously and safely. These outcomes, combined with the results of the literature review, suggest that PLT transfusions should not be withheld when clinically indicated in patients with HIT.     

Bilateral post-traumatic acute extradural hematomas: a report of four cases and review of literature

Bilateral extradural hematomas are rare and follow significant trauma. The mortality is higher than with unilateral single extradural hematomas and postoperative outcome depends on preoperative neurological status.     

胰母细胞瘤的CT表现(2例报道并文献复习)

目的探讨胰母细胞瘤的CT表现,提高对该病的CT诊断水平。方法回顾性分析2例均行CT动态增强扫描并经手术病理证实的胰母细胞瘤的CT表现,并与病理结果对照,总结胰母细胞瘤CT表现特点。结果 2例患者均为婴儿,以皮肤粘膜黄染为主要体征而入院治疗。CT均表现为胰头软组织肿块,边界较清楚,密度不均匀,肿块内均可见沙粒状钙化,伴胰管和/或肝内外胆管轻度扩张,并包绕邻近肠系膜血管和门静脉。1例肿块侵犯邻近十二指肠肠壁。CT增强后,1例表现为较均匀轻度强化,另1例表现为明显不均匀强化。结论胰母细胞瘤CT表现较具特征性,结合临床表现及好发年龄可在术前作出诊断。